Failure to pursue eradication of polio worldwide given the capacity and opportunity to do so is a violation of ethical principles, foremost among them a "duty to rescue" those in distress, according to ethicists writing in this week's edition of the Lancet.
Claudia Emerson, PhD, Program Leader in Ethics, and Peter A. Singer, MD, Director of the Canadian-based McLaughlin-Rotman Centre for Global Health (MRC) at the University Health Network and University of Toronto, present a series of compelling arguments that completing polio eradication is an ethical imperative.
They say the polio eradication agenda in recent years has largely centered on questions of economic and technical feasibility and has come under fire from opponents who strongly support an 'effective control' strategy. However, it is estimated that this alternative to eradication would result in 4 million children contracting polio in the next 20 years.
The authors introduce a moral justification for eradication to the debate, asking: "How can we ethically justify this course of action when the opportunity and means to rescue are available?"
Examining only economic aspects of eradication overlooks "an important moral calculation: the human cost of failing to eradicate," they say. "This is the cost of lives not saved, the lives afflicted by polio (including those family members who care for paralysed children), and the impact of those lives on the future of the broader community."
"Obligations to future generations are difficult to define and may be limited, but if preventing harm is a moral duty, there may be a chain of obligation that persists through generations."
The eradication of smallpox, effectively accomplished in the late 1970s, has resulted in up to 2 million lives saved and 10-15 million smallpox infections prevented annually, the authors say.
"No one is further threatened by this disease. The eradication of polio would similarly achieve global public good. The Global Polio Eradication Initiative has already made strides in this direction: since its launch in 1988, over 2 billion children have been immunized and a 99% reduction in polio has been achieved. Arguably, those who enjoy the benefits of public goods ought to be motivated to act in pursuit of such goods, thus the onus is on the global community to continue supporting polio eradication efforts."
And self-interest adds a strong reason to pursue polio eradication, the authors say. Although polio has been absent from the developed world for over 30 years, the threat of re-emergence looms in a world where people and viruses easily cross international borders. Polio remains endemic in four countries - India, Pakistan, Afghanistan, and Nigeria - and over the years has been exported to previously polio-free countries in sub-Saharan Africa and elsewhere.
Conclude the authors: "We are on the last kilometre of a marathon; surely it is worth crossing the finish line."
The article will be published by the Lancet online April 15 and in the print edition April 17, a month prior to the start of the 63rd session of the World Health Assembly in May in Geneva, at which the Global Polio Eradication Initiative will present its aggressive new strategy aimed at wiping out polio in the next 3 years. The article also coincides with the 55th anniversary of the 1955 announcement by Jonas Salk of the world's first polio vaccine.
The McLaughlin-Rotman Centre for Global Health is based at the University Health Network and the University of Toronto. We envision a world where everyone benefits from new diagnostics, vaccines, drugs and other life science solutions. For more information, please visit us at: www.mrcglobal.org. This study was funded by a grant from the Bill & Melinda Gates Foundation through the Grand Challenges in Global Health Initiative.